S T A T E   O F   N E W   Y O R K
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                                  5349

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            February 25, 2013
                               ___________

Introduced  by  M. of A. GOTTFRIED, ENGLEBRIGHT, JACOBS, PAULIN, CAHILL,
  PERRY, ARROYO, HEASTIE, JAFFEE -- Multi-Sponsored by -- M. of A. BREN-
  NAN, COLTON, DINOWITZ,  GLICK,  GUNTHER,  KELLNER,  LIFTON,  V. LOPEZ,
  LUPARDO, MILLMAN, SWEENEY, TITUS, WEISENBERG -- read once and referred
  to the Committee on Health

AN  ACT  to  amend the public health law and the social services law, in
  relation to medicaid payment for co-payments due under Medicare Part D

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Subdivision 7 of section 273 of the public health law, as
amended by section 7 of part C of chapter 58 of the  laws  of  2008,  is
amended to read as follows:
  7.  No  prior  authorization under the preferred drug program shall be
required when a prescriber prescribes a drug on the preferred drug list,
OR WHEN MEDICAL ASSISTANCE PAYMENT  IS  MADE,  UNDER  PARAGRAPH  (G)  OF
SUBDIVISION  TWO  OF  SECTION  THREE  HUNDRED SIXTY-FIVE-A OF THE SOCIAL
SERVICES LAW SOLELY FOR THE CO-PAYMENT FOR PRESCRIPTIONS PROVIDED  UNDER
PART  D  OF  TITLE  XVIII  OF THE FEDERAL SOCIAL SECURITY ACT; provided,
however, that the commissioner may identify  [such]  a  drug  for  which
prior  authorization is required pursuant to the provisions of the clin-
ical drug review program established under section two hundred  seventy-
four of this article.
  S  2.  Subparagraph  (ii) of paragraph (f) of subdivision 6 of section
367-a of the social services law, as amended by section 42 of part C  of
chapter 58 of the laws of 2005, is amended to read as follows:
  (ii)  In  the  year  commencing April first, two thousand five and for
each year thereafter, no recipient shall be required to pay more than  a
total of two hundred dollars in co-payments, INCLUDING THOSE required by
this  subdivision[, nor] AND, FOR RECIPIENTS ELIGIBLE FOR COVERAGE UNDER
PART D OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY ACT (REFERRED TO IN
THIS SECTION AS "MEDICARE PART D"), THOSE CO-PAYMENTS REQUIRED BY  MEDI-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04596-01-3
              

A. 5349                             2

CARE  PART  D.  NOR  shall  reductions  in  payments as a result of such
co-payments exceed two hundred dollars for any recipient.   THE  COMMIS-
SIONER OF HEALTH SHALL CREATE A SYSTEM TO INCORPORATE CO-PAYMENTS BILLED
TO A RECIPIENT UNDER MEDICARE PART D TOWARDS THE RECIPIENT'S TOTAL ANNU-
AL  CO-PAYMENTS UNDER MEDICAL ASSISTANCE.  AS PART OF THIS SYSTEM, PHAR-
MACISTS SHALL RECORD ALL CO-PAYMENTS DUE UNDER MEDICARE PART D FROM SUCH
RECIPIENTS WITH THE MEDICAL  ASSISTANCE  PROGRAM,  THROUGH  THE  MEDICAL
ASSISTANCE  ELECTRONIC BILLING SYSTEM.  THE COMMISSIONER OF HEALTH SHALL
INCLUDE THE CO-PAYMENTS BILLED UNDER MEDICARE  PART  D  ALONG  WITH  THE
CO-PAYMENTS  REQUIRED  UNDER  THIS  SUBDIVISION  IN DETERMINING WHEN THE
RECIPIENT'S TOTAL ANNUAL CO-PAYMENTS HAVE REACHED TWO HUNDRED DOLLARS.
  S 3. Paragraph (g-1) of subdivision 2 of section 365-a of  the  social
services  law,  as  amended by section 23 of part H of chapter 59 of the
laws of 2011, is amended to read as follows:
  (g-1) drugs provided on an in-patient basis, those drugs contained  on
the  list established by regulation of the commissioner of health pursu-
ant to subdivision four of this section, AND,  FOR  RECIPIENTS  ELIGIBLE
FOR  COVERAGE UNDER PART D OF TITLE XVIII OF THE FEDERAL SOCIAL SECURITY
ACT (REFERRED TO IN THIS SECTION AS "MEDICARE PART D"), PAYMENT  OF  THE
CO-PAYMENT FOR DRUGS PROVIDED BY A MEDICARE PART D PLAN, AFTER THE INDI-
VIDUAL  HAS REACHED THE ANNUAL CAP ON CO-PAYMENTS AS DEFINED IN SUBPARA-
GRAPH (II) OF PARAGRAPH (F) OF SUBDIVISION SIX OF SECTION THREE  HUNDRED
SIXTY-SEVEN-A  OF THIS TITLE, and those drugs which may not be dispensed
without a prescription as required by section sixty-eight hundred ten of
the education law and which the commissioner of health  shall  determine
to  be  reimbursable based upon such factors as the availability of such
drugs or alternatives at low cost if purchased by a medicaid  recipient,
or  the essential nature of such drugs as described by such commissioner
in regulations, provided, however, that such drugs, exclusive  of  long-
term maintenance drugs, shall be dispensed in quantities no greater than
a thirty day supply or one hundred doses, whichever is greater; provided
further  that  the commissioner of health is authorized to require prior
authorization for any refill of a prescription when less  than  seventy-
five  percent  of  the  previously dispensed amount per fill should have
been used were the product used as normally indicated; provided  further
that  the commissioner of health is authorized to require prior authori-
zation  of  prescriptions  of  opioid  analgesics  in  excess  of   four
prescriptions  in  a  thirty-day  period  in accordance with section two
hundred seventy-three of the public health law; medical assistance shall
not include any drug provided on other  than  an  in-patient  basis  for
which  a  recipient  is  charged  or  a  claim  is made in the case of a
prescription drug, in excess of the maximum reimbursable amounts  to  be
established  by  department  regulations  in  accordance  with standards
established by the secretary of the United States department  of  health
and  human  services,  or,  in  the  case  of  a  drug  not  requiring a
prescription, in excess of the maximum reimbursable  amount  established
by  the  commissioner of health pursuant to paragraph (a) of subdivision
four of this section;
  S 4. This act shall take effect on the first of April next  succeeding
the date on which it shall have become a law.